腹横肌平面阻滞联合腹直肌鞘阻滞在腹膜透析置管术中的应用  

Application of transversus abdominis plane block combined with rectus sheath block for peritoneal dialysis catheter placement

作　　者：蔡畅 漆勇 李炎 刘礼霞 张豪杰 

机构地区：[1]李惠利东部医院麻醉科,浙江省宁波市315000 [2]李惠利东部医院肾内科,浙江省宁波市315000

出　　处：《中华肾脏病杂志》2017年第9期686-690,共5页Chinese Journal of Nephrology

摘　　要：目的探讨患者在腹横肌平面阻滞（transversus abdominis plane block，TAPB）联合腹直肌鞘阻滞（rectus sheath block，RSB）的麻醉方式下行腹膜透析置管术的有效性和安全性。方法选择行腹膜透析置管手术患者30例，美国麻醉医师协会（ASA）Ⅰ或Ⅱ级，体重指数（BMI）18～30kg／m^2，随机分为3组：局部浸润组（L组）、TAPB组（T组）和腹横肌平面联合腹直肌鞘阻滞组（TR组）。观察3组患者麻醉前（TO）、麻醉完成后（T1）、手术开始切皮时（T2）、关腹时（T3）、术后6h（T4）、术后12h（T5）和术后24h（T6）等不同时间点平均动脉压（MAP）和心率（HR），记录术中追加局麻药使用量，术后镇痛药使用量，术中及术后24h内视觉模拟疼痛评分（VAS）及围手术期不良反应发生情况。结果T3时间点，L组和T组MAP和HR明显高于TR组（P〈0．05）；T4、T5时间点，L组MAP和HR明显高于T组和TR组（P〈0．05）；L组、T组术中罗哌卡因追加量和术后地佐辛用量明显多于TR组（P〈0．05）；L组术中罗哌卡因追加量和术后地佐辛用量亦明显多于T组（P〈0．05）。L组患者在T3、T4、T5时VAS评分高于T组和TR组（P〈0.05）。3组患者围手术期均未发生不良情况。结论超声引导下TAPB联合RSB用于腹膜透析置管术患者的麻醉效果确切，术中血流动力学稳定，术中及术后镇痛效果良好。Objective To discuss the efficacy and safety of transversus abdominis plane block （TAPB） combined with rectus sheath block （RSB） for peritoneal dialysis catheter placement. Methods Thirty patients, ASA I or II, body mass index （BMI） 18- 30 kg/m^2, were scheduled for elective peritoneal dialysis catheter placement. They were randomly divided into three groups： local anesthesia group （group L）, ultrasound- guided TAPB group （group T）, ultrasound- guided TAPB combined with RSB group （group TR）. Mean arterial blood pressure （MAP） and heart rate （HR） were recorded before （TO） and after （T1） anaesthesia, the beginning of operation （T2） and abdomen-closing （T3）, 6 h （T4）, 12 h （T5）, 24 h （T6） after surgery. The consumption of local anesthetic during the surgery, dezocine after the surgery, the score of visual analogue scale （VAS） during rest and movement at T2-T6 and the adverse reactions were recorded. Results At T3, MAP and HR in group L and group T were higher than those in group TR （P 〈 0.05）. At T4 and T5, MAP and HR in group L were higher than those in group T and group TR （P 〈 0.05）; the consumption of local anesthetic ropivacaine in group L and group T were more than that in group TR （P 〈 0.05）; the consumption of local anesthetic ropivacaine and dezocine in group L were more than that in group T （P 〈 0.05）. The VAS score was significantly lower in group T and group TR at T3, T4, T5 compared with that in group L （P 〈 0.05）. There were no adverse reactions. Conclusion Ultrasound-guided TAPB combined with RSB is safe and efficacious in patients undergoing peritoneal dialysis catheter placement.

关 键 词：腹膜透析 导管 留置 麻醉 局部 腹横肌平面阻滞 腹直肌鞘阻滞 

分 类 号：R692.5[医药卫生—泌尿科学]